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September 1979 


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VADM WHlard P. Arentzen, MC, USN 

Surgeon General of the Navy 

SADM H.A. Sparks, MC, USN 
Deputy Surgeon General 

Director of Public Affairs 

LTJG Richard A. Schmidt, USNR 


Jan Kenneth Herman 

Assistant Editor 

Virginia M. Novinski 

Editorial Assistant 

Nancy R. Keesee 


Vol. 70, No. 9 
September 1979 

1 From the Surgeon General 

2 Department Rounds 

EMT Program at Whidbey Island . . . Navy Volunteers Take Up 
the Slack . . . FortLupton Navy man: From Mechanics to Medicine 

Contributing Editors 

Contributing Editor-in-Chief: CDR E.L. Tay- 
lor (MC); Dental Corps: CAPT R.W. Koch 
(DC); Education: LT R.E. Bubb (MSC); Oc- 
cupational Medicine: CAPT J.J. BeUanca 
(MC); Preventive Medicine: CAPT D.F. 
Hoeffler (MC) 

6 Education and Training 

The Dental Assistant, Class A School 

7 Features 

On Growing Children — Bedwetting: Its Origins and its Cure 
CDR E. Breger, MC, USNR 

10 Adjustment to Overseas Living 
LTM.W. Peterson, MC, USNR 

POLICY: US- Navy Medicine U an official publication 

of the Navy Medical Department, published by the Bureau 
of Medicine and Surgery, h disseminates to Navy Medical 
Department personnel official and professional information 
relative to medicine, dentistry, and the allied health sci- 
ences. Opinions expressed are those of the authors and do 
not necessarily represent the official position of the Depart- 
ment of the Navy, the Bureau of Medicine and Surgery, or 
any other governmental department or agency. Trade 
names are used for identification only and do not represent 
an endorsement by the Department of the Navy or the Bu- 
reau of Medicine and Surgery. Although U.S. Navy Medi- 
cine may cite or extract from directives, official authority for 
action should be obtained from the cited reference 

DISTRIBUTION: U.S. Navy Medicate is distributed to 
active-duty Medical Department personnel via the Standard 
Navy Distribution List* The following distribution is author- 
ized: one copy for each Medical, Dental, Medical Service 
and Nurse Corps officer; one copy for every 10 enlisted 
Medical Department members, Requests to increase or de- 
crease the number of allotted copies should be forwarded to 
U.S. Navy Medicate via the local command. 

CORRESPONDENCE: All correspondence should be 
addressed to: Editor, U. ■£ Navy Medicine, Department of 
the Navy. Bureau of Medicine and Surgery (MED 001D) T 
Washington, D.C. 20372. Telephone: (Area Code 202) 254- 
4253. 254-4316, 254-4214; Autovon 29M2S3, 294-4316. 294- 
4214. Contributions from the field are welcome and will be 
published as space permits, subject to editing and possible 

The issuance of this publication is approved in accordance 
with Department of the Navy Publications and Printing 
Regulations [NAVEXOS P 35J. 


12 Prison Diary 
J.K. Herman 

19 Professional 

A Qualitative and Quantitative Drug Use Review: Cephalosporins 


LTR.E. Whiten, MSC, USNR 

22 Temporal Lobe Seizures Simulating Anxiety Attacks 
CDH J*0. Cavenar, Jr., MC, USNR-R 
CAPT M. A. Harris, MC USN 

24 How I Manage the Patient With Urethral Discharge 
CDR G.R. MacDonald, Jr., MC, USNR 

27 Notes and Announcements 


COVER: Happy inmates of a POW camp in the Yokohama area wave 
to a plane from the USS Shangra-La. This scene was reenacted all 
over Japan as WWII ended. Chief Pharmacist's Mate Adolph Wessel 
Meyers spent four years in camps such as this before he was liberated 
in September 1945, — National Archives 
Story on page 12. 

Navy Committed to Quality Health Care 

The following is an excerpt from a 
recent statement by VADM Willard 
P. Arentzen, MC, USN, Surgeon 
General of the Navy, before the De- 
fense Subcommittee of the House 
Appropriations Committee on Navy 
medical activities. Another excerpt 
from that statement will appear in 
the next issue of U.S. Navy Medi- 

The primary peacetime mission of 
the Navy Medical Department is 
readiness for war. Accomplishing 
this mission depends upon main- 
taining a mobilization base of highly 
trained and experienced active duty 
and reserve personnel, providing 
medical support to active duty per- 
sonnel to insure the health readi- 
ness of the Navy and Marine Corps 
team and planning for immediate 
expansion of medical support to 
meet wartime demands. 

The number of Medical Depart- 
ment personnel required to meet 
projected wartime needs exceeds 
the requirement for peacetime sup- 
port of the relatively young and 
healthy active duty force. During 
peacetime, these medical assets are 
used to support the secondary 
peacetime mission of the Medical 
Department, the provision of a 
health care benefit to the families of 
active duty personnel, and to retired 
personnel and their dependents. In 
turn, dependents and retired per- I 
sonnel provide the broad spectrum 
of patients necessary to maintain 
essential skill levels of medical per- j 

The delivery of health care and 
the maintenance of a highly skilled 
and responsive Medical Depart- 
ment force are dependent upon pro- 
viding adequate operational funds, 

Volume 70, September 1979 

recruiting and retaining qualified 
personnel, and providing adequate 
facilities, equipment, and ancillary 

Health Care Environment 

Health care benefits continue to 
be a foremost consideration among 
active duty personnel when making 
career decisions. This has been re- 
flected by the intensity with which 
all beneficiaries have voiced their 
disappointment over the gradual 
erosion of direct health care avail- 
ability. Publications directed toward 
military personnel as well as public 
media amplify the concern which 
exists over a multitude of factors 
that have directly and indirectly 
impacted on the quantity of care 
available. Although this type of 
concern is frequently brought to my 
attention, I continue to resist impli- 
cations suggestive of any possible 
future compromise in the quality of 
care provided. The Navy Medical 
Department is committed to main- 
taining the highest level of health 
care at all medical facilities. 

The total support of high quality 
total health care assumes a variety 
of mutually supportive factors, and 
the interdependence of each of 
these similarly affects the magni- 
tude of the health care services pro- 

Physician Recruiting and Retention 

Physician recruiting and reten- 
tion have been a matter of concern, 
to the Navy, the Department of De- 
fense, and to the Congress, for sev- 
eral years. The Armed Forces 
Health Professions Scholarship Pro- 
gram established by Congress in 
anticipation of the requirements of 

the All-Volunteer Force is the pri- 
mary source of input to the Medical 
Corps. It currently authorizes 1,575 
positions of which 96 percent are 
designated for medical students. 
These students incur an active duty 
obligation to the Navy. 

Our ability to attract qualified 
medical students with this program 
is dependent on the Armed Forces 
Health Professions Scholarship Pro- 
gram being competitive with the 
National Health Service Corps 
Scholarship Program. At the pres- 
ent time, the Armed Forces Health 
Professions Scholarship Program is 
not fully competitive. This was re- 
inforced by a declination rate of 27 
percent during FY 78. 

Dental student inputs into this 
program ceased in FY 78 and the 
available spaces have been repro- 
grammed to increase medical stu- 
dent inputs to reduce the medical 
officer shortage. In the future, di- 
rect recruitment will be the main 
source available for acquiring den- 
tal officers. The Navy Recruiting 
Command is currently providing 
adequate numbers of dental candi- 

In order to fortify this method of 
acquisition, we are working very 
closely with Navy Recruiting Com- 
mand, in anticipation of the de- 
pendence on direct dental recruiting 
after the last scholarship candidates 
graduate in 1981. There is some 
skepticism about the ability to re- 
cruit the number of dental officers 
necessary after the last of the 
scholarship students graduate. 
However, because of the limited re- 
cruiting effort in the past, it is not 
clear at this time if total recruiting 
can be successful. 

(To be continued) 


EMT Program at Whidbey Island 

Seattle, Wash., has been labeled 
with many adjectives — "Gateway to 
Alaska," "Most Livable City in the 
United States," and "The Best 
Place to Have a Heart Attack," 
among others. This last designation 
reflects Seattle's singularity in hav- 
ing been the first city in the United 
States to establish a "Medic One" 
program (the paramedics of Seattle) 
as well as "Medic Two" (a com- 
munity-sponsored program) aimed 
at instructing the general populace 
in CPR (Cardiopulmonary Resusci- 
tation). One-third of the citizens 
living in Seattle have been trained 
through this program. 

Sixty miles to the northwest of 
Seattle on an island in the Strait of 
Juan De Fuca, lies Naval Hospital, 
Whidbey Island. This facility, like 
neighboring Seattle, also holds a 
proud and singular distinction — 
that of being the first naval medical 
activity in the Thirteenth Naval 
District to organize and implement 
its own ongoing Emergency Medi- 
cal Technician Training Program. 

Due to the isolated location of the 
naval medical facility and the large 
number of personnel it supports, 
the command determined that the 
already intensive training received 
by hospital corpsmen should be 
augmented. With this in mind, the 
naval hospital established and im- 
plemented the first of ten 82-hour 
courses for the training of Emer- 
gency Medical Technicians in Au- 
gust 1974. 

The Emergency Medical Techni- 
cian (EMT) is the first link in the 

EMT team evacuates a patient via search and air rescue helicopter. 

chain of emergency medical ser- 
vices. The EMT is usually the first 
paraprofessional on the scene of an 
injury or illness. To perform this 
responsibility properly, the EMT 
must be trained and indoctrinated 
in the many and varied aspects of 
field emergency medicine. 

Standards for the course are 
established by the U.S. Department 
of Transportation, with certification 
granted under the auspices of the 
Washington State Department of 
Social and Health Services. Each 
student receives intensive training 
and indoctrination in the highly 
technical area of cardiopulmonary 
resuscitation, medical emergencies, EMTs monitor patient's heartbeat. 

U.S. Navy Medicine 

environmental injuries, emergency 
childbirth, trauma, operation of 
emergency vehicles and equipment, 
patient handling and extrication, 
and the medicolegal aspects of 
emergency medicine. 

In its infancy, the EMT program 
was staffed by personnel of the 
naval hospital with a medical officer 
serving as the physician coordina- 
tor, and hospital corpsmen already 
certified as Washington State Emer- 
gency Medical Technicians fulfilling 
responsibilities of lay instructors. 

The courses were originally con- 
ducted within the naval hospital 
facilities and are presently held at 
Skagit Valley College which grants 
five hours of college credits in the 
field of Nursing upon completion of 
the program. Medical Department 
personnel continue their involve- 
ment as physician coordinators and 
lay instructors. 

Presently, all hospital corpsmen 
assigned to the emergency room 
and the search and rescue crew are 
certified by the State of Washington 
as Emergency Medical Technicians. 
Additionally, several graduates of 
the EMT program are currently as- 
signed to the Operating Forces 
afloat. One alumnus was instru- 
mental in implementing an EMT 
syllabus on board the USS Enter- 

All hospital personnel, regardless 
of their speciality, are eligible to 
participate in this training provided 
they meet the prerequisites for 
enrollment established by the 
Washington State Department of 
Social and Health Services. 

Since its inception, the program 
has graduated a total of 81 hospital 
corpsmen and 14 auxiliary person- 
nel from the station security force 
and fire department. 

There are currently 24 Washing- 
ton State certified EMTs assigned 
to Naval Hospital, Whidbey Island 
with 21 prospective EMTs enrolled 
in the summer session. 

Volume 70, September 1979 

The implementation of this pro- 
gram has proven to be of benefit not 
only to the individual but to the 
command, local community, and the 
Navy Medical Department. Above 
all, the primary beneficiaries are 

the sick and injured who rely upon 
the professional services of the 
Emergency Medical Technicians. 

—Story by HM1 W.F. Ebarb, USN and 
HM2 R.K. Prendergast, USNR-R. Photo- 
graphs by PH3 L.A. Vendetti, USN 

Navy Volunteers Take 
Up the Slack 

Twenty-two volunteer doctors, hos- 
pital corpsmen, nurses, and Medi- 
cal Service Corps officers from 
NRMC Orlando, recently traveled to 
Daytona Beach, Fla., where they 
performed physicals on 205 disad- 
vantaged youths. 

The NRMC's Family Services 
Department, headed by CAPT 
Victor Romano, worked in conjunc- 
tion with Bethune-Cookman College 
of Daytona Beach in setting up the 
second annual physical program by 
NRMC Orlando. 

In the past, physicals were con- 
ducted by the Air Force until cut- 
backs forced them to disband the 
program. Under the auspices of Dr. 
Romano, NRMC Orlando picked up 
the ball and the program was kept 

Youths receiving the physicals 
entered the National Youth Sports 
Program sponsored by the Depart- 
ment of Health, Education and Wel- 
fare. Physicals were needed before 
the youths could participate in the 
sports program. 

HM3 Larry Brown checks the blood pressure on a budding athlete. 

Fort Lupton Navyman: From 
Mechanics to Medicine 

After four years in the Air Force 
fixing planes, Jerry Holcomb is now 
fixing people aboard the Seventh 
Fleet guided missile cruiser, USS 

"I enjoyed my four years as an 
airman and I learned a good trade," 
says HM2 Jerry R. Holcomb, "but I 
wanted to work in the field of medi- 
cine, not jet mechanics." 

Today, the Fort Lupton, Colo., 
native is assigned to the two-man 
Medical Department aboard the 
USS Home, currently deployed with 
the Seventh Fleet in the Western 
Pacific. Here he tends to the 
medical needs of more than 450 

"Someday I'll become a doctor," 
said the 25-year-old corpsman. 
"I've wanted to work in medicine 
since my high school days." 

Upon graduation from Fort Lup- 
ton High in 1972, Holcomb got a job 
as an X-ray technician orderly and 
later attended Aims Junior College 
in Greeley, Colo., while majoring in 
radiology. Here he realized the 
medical field was his lifelong ambi- 

"When I enlisted in the Air Force 
I tried to get into the medical field 
but ended up playing nursemaid to 
B-52 bombers," he said. "It was 
quite a let down. But I kept telling 

HM2 Jerry R. Holcomb 

myself to keep studying; if I wanted 
it badly enought I'd get it. That's 
what I'm doing in the Navy. I was 
guaranteed the hospital corpsman 

Sick call, lab work, reports, 
records verification and screening, 
sanitation inspections, and daily 
water sampling are but a few of the 
"Doc's" responsibilities aboard the 

"It's a demanding job, but I love 
it. The men rely on me. When they 
come to my office they come for a 
good reason. I find it difficult to tell 
a patient to come back during sick 

call hours, even if I'm up to my neck 
in paperwork. Removing a cyst or a 
toenail, or stitching people up are 
common occurrences. I like to help 
others, to contribute to their well- 

The former airman tries to put 
himself in a patient's position. "I 
feel for someone who's ill, I try to 
examine my patients for all possible 
symptoms and make them feel com- 
fortable. It makes for a better rela- 
tionship and that's important to 

Prior to assuming his medical 
duties on the Home, Holcomb at- 
tended 10 weeks of technical medi- 
cal training at the Navy's Balboa 
Hospital in San Diego. He then re- 
quested pharmacy school, but after 
nearly three months of a six-month 
course, and while maintaining a 97 
grade point average, he withdrew. 

"The course was outstanding," 
he said, "but I realized it wasn't 
what I wanted to do. I'd rather work 
with patients on a one-to-one basis. 
So I was assigned to the pediatric 
ward at Balboa for a year." 

There is no doctor on board the 
Home. When an emergency arises, 
Holcomb and his co-worker diag- 
nose and treat the patient until he 
can be evacuated to the nearest 

U.S. Navy Medicine 

USS Home in the Western Pacific 

The highlight of the Navy veter- 
an's two-year career was a four- 
month South Pacific cruise. "The 
Navy has taken me places that most 
people only dream of — Tahiti, New 
Zealand, Australia, Fiji, American 
Samoa, and Raratonga. They're all 
interesting places, but New Zealand 
tops them all. It's so beautiful. 
People's lives seem so uncompli- 
cated. They are fun-loving and care- 
free. The whole experience was 
great and it was like opening a 
passage between the U.S. and 
South Pacific. ' ' 

In addition, Holcomb has visited 
Hong Kong, Thailand, Japan, and 
the Philippines. 

"Join the Navy and see the world 
is definitely a fact," he said. 

— Story and photos by PH/JO Ken A. 
George, USN. 

Volume 70, September 1979 

HM2 Holcomb consults a book on microbiology while reading a slide. 


The Dental Assistant, Class A School 

The Dental Assistant, Basic, Class 
A School, along with the other den- 
tal technician schools, recently cele- 
brated the first anniversary in new 
facilities located at the Naval School 
of Dental Assisting and Technology, 
San Diego, Calif. The curriculum, 
as with all curricula at the school, 
has been converted from a sub- 
ject-based, lecture/demonstration 
course of instruction. The task- 
based curriculum consists of 17 
educational modules containing in- 
dividual study guide/workbooks 
which are complimented by over 70 
locally prepared videocassettes. 
Each task is performance tested by 
a staff facilitator. The program with 
the exception of selected modules, 
is individualized to the point where 
trainees can essentially proceed 
through the course at their own 
pace. The use of locally prepared 
videocassettes allows students to 
repeatedly view demonstration and 
instructional tapes, thereby ena- 
bling facilitators to devote more 
time to individual student assist- 

Due to a shortage of dental tech- 
nicians, the school is temporarily 
operating on a 10-week instead of 
the normal 12-week curriculum, 
during which each student is ex- 
pected to complete a 245-item task 
list.* Primary emphasis is placed on 
charting, assisting the dental officer 
in providing treatment, preventive 
dentistry, and dental radiology. 
After sufficient practice on a simu- 
lated patient, each student com- 

*The 12-week schedule will resume 9 Oct 79 

Dental recruit being tested on oral prophylaxis procedures 

pletes a clinical prophylaxis and 
takes one complete set of radio- 
graphs on a classmate. Upon gradu- 
ation, trainees are assigned to den- 
tal facilities ashore, afloat, and with 
the Fleet Marine Force. 

Classes are convened at 3-week 
intervals and four classes run 
concurrently. The maximum stu- 
dent capacity for each class is 50. 
The staff presently consists of 29 
facilitators and teaching assistants. 
The average facilitator/student 
ratio is 1:7, affording maximum op- 
portunity for individualized instruc- 

Personnel desiring more informa- 
tion concerning admission require- 
ments and application procedures 
should contact their Educational 
Services Office or Career Counselor. 

Dental recruit practices film placement 
procedures for taking intraoral radio- 

U.S. Navy Medicine 

On Growing Children 

Bedwetting: Its Origins and its Cure 

CDR Eli Breger, MC, USNR 

A new series, On Growing Children, begins this month 
in U.S. Navy Medicine. The articles are directed toward 
those Navy health care professionals working with chil- 
dren and their families. 

"Train up a child in the way he should go and when he 
is old he will not depart from it," Proverbs 12.6 

Bedwetting is one of the most commonly seen prob- 
lems of developing children. However, its origins re- 
main poorly understood. Enuresis is the medical term 
for a child wetting his bed or clothing beyond the age of 
expected control. It is present in about one of five chil- 
dren upon their starting school and this percentage 
decreases with each additional year of age. However, 
even at the age of approaching adolescence a small but 
significant number of children continue with this symp- 

Although the problem appears similar in virtually 
every child it is not a singular condition in its origin. In 
a given child bedwetting is due to several factors com- 
ing together and bringing about the symptom. Further- 
more, as the child passes from one stage of develop- 
ment to another the original meaning of the symptom 
may be layered over by newer ones and become more 

Most parents believe their bedwetting children can- 
not help themselves and therefore need understanding. 
This concept is basically true but it is far from easy to 
hold when each morning the parent finds the bed wet 
and has to change the linen. Mother is likely to see her 
child as inadequate and her own parenting role as a 
failure. From my own clinical experience I conclude 
that parents' attempts at coping are more rewarding 

CDR Breger is Chief of the Psychiatry Service at the Naval Hospital 
Beaufort, S.C. 29902. Copyright 1979 Eli Breger, M.D. Ail rights 
reserved. May be reprinted or reproduced within the Navy for non- 
profit type educational purposes in keeping with the fair use doctrine. 

Volume 70, September 1979 

when they understand the diverse roots of the condition 
and the specific workings in their own child. In this 
essay I attempt to integrate what is generally known or 
theorized regarding the origins of enuresis. Hopefully, 
this will help parents to more precisely understand the 
problem in their own children. Suggestions for amelio- 
ration will than be discussed. 

Physical Factors 

Considerable attention has been focused on the role 
of physical factors. Many studies have been done using 
techniques to observe the urinary system. In a small 
number of bedwetting children, not exceeding five 
percent, signs of disease or birth abnormalities have 
been discovered. These exceptional cases can be diag- 
nosed by the physician through a careful history, physi- 
cal examination, and appropriate laboratory proce- 
dures. Frequent and painful urination or a dribbling 
flow upon emptying the bladder suggests a physical 

Hereditary Considerations 

A hereditary basis for this condition has been sug- 
gested based on findings describing histories of bed- 
wetting in parents and siblings of the bedwetting child 
as being significantly higher in number than in the 
general population. One view conceives bedwetting as 
reflecting an "irritable bladder" which is the result of 
an inherited sensitivity of the bladder musculature 
causing it to contract and empty even at normal urine 
pressures. Indeed one commonly sees children who 
urinate frequently and seek the bathroom urgently. 
Another notion holds that bedwetting children, by 
heredity, have a poorly developed ability to coordinate 
the complex bladder muscle groups which go into 
tightening up and holding back or relaxing and voiding. 
However, the studies have never been conclusive. Even 
those who view the condition as hereditary concede that 
only a potential for bedwetting may be genetically 

transmitted. This becomes symptomatic only under 
specific environmental or psychologic conditions. 

Psychologic Roots 

Presently, opinion has shifted to regard bedwetting 
as a psychological manifestation sometimes added on to 
physical and hereditary inclinations. The psychological 
roots of the problem are several. 

The role of inadequate basic toilet training is pri- 
mary. The child's problem is viewed as a develop- 
mental problem in learning. That is, the child has never 
learned how to control the urge to urinate. There are 
parents who train in a premature, excessive, or punitive 
manner. In vulnerable children this leads to a fixation 
of wetting and represents a retaliatory and negativistic 
response. These children are frequently passive and 
submissive. They have great difficulty in expressing 
anger and displaying aggression but express these op- 
positional feelings through bedwetting. 

There are mothers who share a deep sympathy with 
their child's bedwetting because of unsolved conflicts 
in their own early training. They are unable to help the 
child develop the necessary attitudes of shame and un- 
acceptability which enable him or her to assume re- 
sponsibility for control these parents tend to infantalize 
and indulge their offspring thereby depriving them of 
growth fostering stimulation so vital for learning. With- 
out conscious awareness they relive their own child- 
hood experiences through their children's training. 
Such children are characterized by immaturity in their 
overall development. When they speak their minds 
they say, "How could anyone expect me to control my 
bedwetting when I am so young, so small, and so deep- 
ly asleep?" Some children may say, "If I do what is 
asked of me and become dry, what will be asked of me 
next by way of grownup behavior? No, that's not for 

My own clinical work leads me to conclude that the 
largest percentage of cases is related to inadequacies in 
toilet training. 

There are some children who persist at this infantile 
developmental level because there is something 
pleasurable in "letting go," feeling the decrease in 
bladder pressure and the warm sensation of urine 
flowing along their thighs. All children probably feel 
this way early on but the bladder normally comes under 
control, on a psychological level, in response to shame 
and training. For some bedwetting children this sensa- 
tion has such heightened intensity that the process be- 
comes protracted and learning does not take place. 

In the minds of some children unable to master the 
process of urinary control, bedwetting is perceived as a 

defect or imperfection. This is especially so when real 
imperfections exist such as with a physical handicap, 
intellectual inadequacy, or an underdeveloped penis. 
As the bedwetting continues the child's perception of 
having a physical defect intensifies and further hinders 
the mastery of control. 

Enuresis commonly appears in previously trained 
children who are suddenly placed in acute and stressful 
situations. There is a developmental retreat to an 
earlier and more satisfying period when control was not 
necessary and life simpler. The stress may be realistic 
and external such as loss of a parent, birth of a sibling, 
serious illness, surgical procedure, or perhaps worri- 
some parental discord. The stress may be internal 
relating to conflicts with which all children struggle at 
each phase of development. By means of bedwetting 
the child circumvents the anxiety provoking problem 
and as a result shows less obvious tension. 

It would appear that bedwetting has a different 
psychologic basic in different children. The meaning 
can change and operate on several layers with increas- 
ing age. Constitutional factors may play a role in this 
multiply determined problem. Once bedwetting is 
established other emotional difficulties and personality 
changes are bound to follow. It is even quite possible 
for the symptom's original cause to become extinct and 
for it to continue as an isolated and learned response. 

Advice for Management 

How can parents help their bedwetting children? As 
in all of life an ounce of prevention is worth a pound of 
cure. Nighttime toilet training should be undertaken 
toward the end of the second year of life when the child 
shows signs of readiness such as occasional dry nights. 
The essence of successful training rests in the appro- 
priate and clear communication of the message that 
control is desirable, the child has it within him to attain 
this but that it will require working on. The mother's 
role then becomes supportive, diligent, and insistent. 
She must avoid the pitfalls of harshness and punish- 
ment on the one hand and haphazard indulgence on the 
other. Talk about it, ask the child to try, suggest that he 
has it within him to succeed, praise successes and 
express disappointment with failures. Always hold out 
a positive and hopeful expectation for the next night. 

To stop bedwetting in the older or regressed child, 
training as discussed above is primary. Most children 
want to be dry but have given up hope. Attempt to 
rekindle that expectation. Once his desire to be dry is 
genuinely expressed spend some time with him each 
night at bedtime urging him to think about the problem 
and encouraging him to try hard. The concept of 

U.S. Navy Medicine 

putting a small active part of his mind on duty through 
the night as a "sentry" to stand guard over his bladder 
has proven helpful. When the bladder fills up the 
"sentry" will alert him to get up and void or urge him 
to tighten up and continue to sleep. Praise successes 
and when he fails hold out hope that tomorrow night 
will be better. Have him keep a calendar record of his 
progress to strengthen this "suggestive-supportive" 

This program should be maintained over many weeks 
to judge its effectiveness. If there is no positive re- 
sponse, discontinue and suggest to him he may be more 
ready to succeed several months hence. Try again at 
that time. With positive reponse continue the process 
for several months to consolidate gains and make them 

Limiting reasonable amounts of fluid in the evening 
has been traditional but not effective. However, insist- 
ing that the child void before getting into bed makes for 
good training. Additionally, having him void before the 
parents retire is useful only if he can be successfully 

There are older bedwetting children who wear 
diapers at night because of parents' insistence or their 
own desire. This is unadvisable. It clearly communi- 
cates to the child the inappropriate message that he is 

expected to wet. It would be far better for him to be re- 
sponsible for changing his bed linen in the morning. 
This is a realistic way to deal with the result of his 
problem. Hopefully it will enhance the development of 
motivation to stop wetting. 

There are several medications which may help a child 
in his endeavors. They should not be viewed as replace- 
ments for the above program but as additions to it. 
They can be explained to the child as helping agents for 
strengthening his "sentry." These products can be 
prescribed only by the family physician. 

Retraining through conditioning devices which 
either ring a bell or light a bulb thereby awakening the 
bedwetting child as his urine soaks through an electric 
pad under his sheet is yet another approach to be at- 
tempted if the above described methods fail. 

Should repeated attempts at training fail and the 
child advance well into the elementary school years, 
one must assume the problem to be a deep and complex 
one requiring the expertise of a child psychiatrist. Natu- 
rally, the possibility of a physical basis for the bedwet- 
ting must be kept in mind at all times and clarified. 

"A tender nest of soft young hearts, each to be sepa- 
rately studied, curious eager flock of minds to be 
severely pained and tutored." Tupper 

AMA Prescribing Guidelines 

• Use barbiturates and other sedative- hypnotics 
for relief of severe symptoms, but avoid them for 
minor complaints of distress or discomfort. 

• Attempt to diagnose and treat underlying dis- 
orders before relying on drugs of this class for symp- 
tomatic relief. 

• Assess susceptibility of the patient to drug 
abuse before prescribing barbiturates or any other 
psychoactive drugs. Weigh benefits against hazards. 

• Use dosages that will not lower sensory percep- 
tion, responsiveness to the environment or alertness 
below safe levels. 

• Know how to administer barbiturates when clin- 
ically indicated for withdrawal in cases of drug 
dependence of the barbiturate type. 

• Using periodic checkups and family consulta- 
tions, monitor possible development of dependence 

in patients who are on an extended sedative-hypnotic 

• Prescribe no greater quantity of a drug than is 
needed until the next checkup. 

• Warn patients to avoid possible adverse effects 
because of interaction with other drugs, including 

• Counsel patients as to the proper use of medica- 
tion — follow directions on the label, dispose of old 
medicine no longer needed, keep medicine out of 
reach of children, do not "share" prescription drugs 
with others. 

• Convey to patients through your own attitude 
and manner that drugs, no matter how helpful, are 
only one part of an overall plan of treatment and 

— Reprinted with permission of Roche Laboratories 

Volume 70, September 1979 

Adjustment to Overseas Living 

LT M.W. Peterson, MC, USNR 

Successful adaptation to overseas 
living necessitates knowledge of 
certain physiologic and psychologi- 
cal processes. Psychologic adjust- 
ment depends on personality char- 
acteristics that include adaptability, 
flexibility, and intelligence. A re- 
view of a number of studies exam- 
ines the adjustment of people 
adapting to new cultures. (/) Com- 
mon throughout these studies is the 
fact that everyone undergoes major 
changes when in a new culture and 
these changes can either result in 
adaptive growth or maladaptive 

Separation. The first task of ad- 
justment to a foreign culture is 
dealing with separation issues. 
Often, young adults are having to 
leave home for the first time. Virtu- 
ally everyone leaves behind some 
family members, if not many close 
friends. This change in living in- 
volves geographic separation, mov- 
ing a house and belongings, and 
undergoing some modification of 
job. These kinds of changes in living 
patterns (even if the change in- 
volves a promotion) increase the in- 
cidence of physical and emotional 
illness. (2) Thus many travelers find 
themselves having to cope with an 
illness (though usually mild) when 
adjusting overseas. 

LT Peterson is chief of psychiatry at U.S. 
Naval Regional Medical Center, Yokosuka, 
FPO Seattle 98675. 

Jet Lag. A major physiologic 
adaptation confronts the traveler 
when he arrives. It has been dem- 
onstrated that there is a decrease in 
REM (Rapid eye movement) sleep 
after trans- Atlantic air travel. (J) 
This and circadian rhythms are 
often disrupted for weeks after an 
overseas flight. At least a day of ad- 
justment is needed for each hour 
gained or lost through time zone 
changes. (4) 

Personal experience with a trans- 
Pacific move revealed to this ob- 
server that for a number of days 
(indeed for two or three weeks) 
sleep patterns were disturbed and 
fatigue was quickly felt. Often with- 
in a 24-hour period one feels alter- 
nately energetic, even euphoric, 
and then after one or two hours this 
euphoria quickly changes to fatigue 
and depression. It is speculated that 
this cycling of mood is secondary to 
a natural tendency of the brain to 
continue its cycle of REM sleep 
activity while in the waking state. (5) 
Perhaps the cyclic fatigue felt after 
a switch in day-night schedule 
comes up whenever the brain 
should be passing through REM 
sleep (which would be about every 
90 minutes during a normal night's 

Culture Shock. Psychological ad- 
justment to cultural change occurs 
in a characteristic "W" pattern. (6) 
Initially, expectations are high, the 
new culture has excitement and new 

adventures are enthusiastically be- 
gun. When the difficulties of learn- 
ing a new language emerge, when 
the new culture loses its glow, and 
when the deficiencies of the alien 
country become more evident, a de- 
cline in adjustment occurs. Depend- 
ing upon the expected length of 
overseas living this decline may be- 
come evident within a few weeks, 
but usually appears about six 
months after arrival. 

A similar phase of adjustment 
occurs when a professional enters a 
new system or community. There is 
a "honeymoon" phase of adjust- 
ment when the newcomer can do no 
wrong and all doors are open. When 
this period ends and the reality of 
the newcomer's situation becomes 
evident, there is often a decline in 
interest, energy, and performance. 
As the anticipated end of over- 
seas living approaches, a renewed 
energy and enthusiasm for the non- 
native culture occurs. This positive 
approach lasts until the transition 
back to the native culture is made. 
Another backslide occurs when the 
old culture is reassessed in light of 
the new experiences and knowledge 
gained. Acquaintances have to be 
renewed, ties with relatives become 
tighter, perhaps even restrictive. 
Again a change in work position, 
separation from friends, and loss of 
"foreigners" status have to be con- 
tended with. 

The manner in which a person 
adjusts depends mostly upon his or 


U.S. Navy Medicine 

her underlying personality, It is 
very difficult to predict with cer- 
tainty how an individual will do, but 
if a person maintains an open, opti- 
mistic attitude, remains active in 
seeking out fresh knowledge of the 
culture, he will tend to adjust better 
than a person who is inflexible, and 
cannot bounce back from the inevi- 
table mistake made when trying to 
communicate across cultures. Hu- 
mor and a strong sense of self- 
worth are assets. Accumulated 
experience with Peace Corps volun- 
teers has shown that placement in 
an urban area, high ability to learn a 
new language, having a well-de- 
fined and familiar occupation that is 
gratifying, having control over the 
situation, and being in a culture that 
is fairly similar to the native culture 
will increase a person's chances of 
good adjustment. (7) 

The Dependent Spouse. There 
appears to be a greater difficulty for 
a non-working dependent spouse to 
adjust to overseas living. Two 
factors contribute to this. First there 
is not a well defined role for a de- 
pendent. Since there is neither an 
extended family nor a group of close 
friends to relate to there is enforced 
dependency upon the working 
spouse. Secondly, the relatively idle 
spouse often has much more contact 
with the alien cluture as in food buy- 
ing, taking care of household 
chores, and making brief sight- 
seeing trips. The increased expo- 
sure can mean more stress. 

Little America. There is a definite 
cultural adjustment also to the en- 
clave of Americans that make up the 
military base or foreign community. 
Initially, or if proper adjustment to 
the foreign culture is not made, the 
base or an American club becomes 
the center of most socializing, and is 
the provider of necessities and en- 
Volume 70, September 1979 

tertainment. Its small town atmo- 
sphere is very different for urban- 
ites who transfer from the U.S. On 
the positive side, as the overseas 
family adjusts and spends more 
time exploring the host country's 
culture, the base or American 
community can provide a comforta- 
ble piece of Americana, where the 
traveler can rest and replenish his 
energy for further sojourns. It also 
can be a place to visit with foreign 
friends and show them aspects of 
American culture. 

Alleviating the Symptoms. Prom 
these studies and treating dis- 
tressed families it is evident that 
adjustment can be smoother. Physi- 
cal adjustment is easier if the travel- 
er allows his circadian rhythms to 
return to normal as fast as possible. 
Imbibing alcohol during or after a 
lengthy flight delays and makes 
more difficult the physiologic ad- 
justment that has to occur. Ethanol, 
barbituates, and amphetamines 
suppress REM sleep; in addition 
REM sleep time is decreased after 
trans-Atlantic flights. REM depri- 
vation results in fatigue and de- 
creased tolerance for stress. There- 
fore, adding a REM suppressing 
medication to a traveler already 
REM deprived can only make ad- 
justment that much more difficult. 
If a person cannot naturally readjust 
his sleep/wake cycle, use of Flur- 
azepam HCL (Dalmane® ) at bed- 
time for a few days would be of 
great help, since it and other 
benzodiazapines do not alter REM 
sleep. Rest after arrival is essential. 
Major decision making, beginning 
new ventures, extensive sight-see- 
ing, etc. should be delayed until the 
body has overcome the shock to its 
circadian rhythms. 

Exposure to someone knowledge- 
able about the new culture can be of 

immense benefit. The U.S. Navy, 
for example, has a sponsor system 
that, if utilized properly, makes ad- 
justment go smoothly. Newly ar- 
rived personnel are met at the air- 
port by a person close in age, mari- 
tal status, and rank, whose job is to 
help out with adjustment in the first 
few weeks. 

Practical instruction (the U.S. 
Navy's Inter-Cultural Relations 
workshop) in the cultural mores and 
basic language training will give a 
newly arrived foreigner a sense of 
assurance; mastering the foreign 
culture's nuances can begin quickly. 

Isolation from others, withdrawal 
to an unvarying routine, or constant 
contact only with Americans is a 
kind of adjustment, but a poor one. 
Taking some risks in venturing out 
into a foreign land will allow an op- 
portunity for learning. Contact with 
a culture other than our own in- 
j creases to a huge degree knowledge 
about our own. Personal growth 
should be the outcome of residence 


1. Brein M, David KH: Intercultural 
Communication and the Adjustment of the 
Sojourner. Psychological Bulletin 76(3):21S- 
230. 1971. 

2. Holmes TH. Rahe RH: The Social Re- 
adjustment Scale. J Psychosomatic Res 11: 
213, 1967. 

3. Evans JI, et al: Sleep and Time Zone 
Changes. Archives of Neurology 26{l):36-48, 

4. Luce GG: Body Time. Bantam Books, 

5. Dement WC, Miller MM: An Over- 
view of Sleep Research: Past, Present, and 
Future. American Handbook of Psychiatry, 
12th ed, p 166, 1975. 

6. Gullahorn JT, Gullahorn JE: An Ex- 
tension of the J curve Hypothesis, 19(3):33- 
47, 1963. 

7. Hautalouma JE, Kaman V: Descrip- 
tion of Peace Corps Volunteers Experience in 
Afghanistan. Topics in Cultural Learning. 
Richard Breslin (ed). East West Center 
Honolulu, Hi., Vol. 3. 1975. 


Prison Diary 

In 1967 Isabel! C. Meyers of Long Beach, Calif., do- 
nated to BUMED a diary, medical kit, and wartime 
mementoes of her late husband. Chief Pharmacist's 
Mate and later CDR Adolph Wessel Meyers, MSC, 
USN. The diary, written while Meyers was a POW, 
gives a vivid and often poignant account of deprivation, 
sacrifice, and survival. It also documents one man 's 
heroic effort to ease the suffering of his comrades. 

On the day of his capture, Adolph Wessel Meyers 
was 36 and had already spent nearly half his life in the 
Navy, most of that time as a corpsman aboard battle- 
ships and as a medic with the Marine Corps. 

Chief Meyers was a short but exceedingly strong 
man for his size with clear, blue eyes and just a 
sprinkling of gray hair. His quick and winning smile 
endeared him to his patients. Those who knew him 
benefited from his warmth, cheerfulness, and generos- 

When Japanese bombs fell on Guam 8 December 
1941, Meyers was on duty in the personnel office of the 
U.S. Naval Hospital in Agana. Two days later he be- 
came a prisoner of war. 

Through much of the next 45 months and four prison 
camps or bunshos, he kept a diary. In August 1944, 
after his captors began again to confiscate personal 
effects and other contraband, the document was smug- 
gled out of prison by a friendly Japanese. 

The diary's entries are often terse but revealing. 
Ever wary of his Japanese guards, and with life itself 
reduced to its simplest common denominator, Meyers 
wrote only about essentials — passing the time, simple 
and rare pleasures, fleas, bed bugs, and the illness, 
treatment, and tragic loss of his buddies. Important 
dates he highlighted in red — his wedding anniversaries 
and the birthdays of his loved ones were ever on his 

We can read between the lines and perceive the 
loneliness, the boredom, and the brutality. Yet we also 
sense a modest man whose inner strength and dogged 
persistence sustained him and his patients through four 
long years of captivity. 

"The Navy Department announced that it is unable 
to communicate with Guam either by radio or cable. 
The capture of the island is probable." (1) 

This terse communique issued by the Navy 13 De- 
cember 1941 reported the probability of an event that 
had already taken place. 





I Z,?,4 /i- L 




U-i ZUS 



i JaPan decUmed AJOf On Lib. Fko.r\ Harbor 
and G«ao.w> bombed. U. :>.:>. renown cwnv.. 
ffeitrtcted to Kos»Pi1ul- 
Guam bombed <ma mackuie qimru'd, 
VH'fed aferaTe on c«»uaHv-&. 

I Olbuatrt CAftured Oit 6 5 50. ftlaJc a Pr»>oner 
a*\d conhned al" ho^piTod. 


In Charge a\ uWd'ftj Jill paTi««Ti nnwtj 
■Vh«.re./0 Hospital {Jcwi».jtT\«i j1a^ed-r-_ T 
wyjvtA -tb Cikitaoltc Church. \v -Jons m 
<ja.lle^ ( t> ir\ la^nJr j and + u* wa»*d- 

l# Uic+orf P»raae b^ Taps 

2. 5 Oaeorated Uard. ffetjukxr Chmtknas. 

A page from history. Meyers has the attack on Pearl Harbor 
occurring on the 8th because Guam is located on the western 
side of the International Date Line. 

The end for Guam had begun shortly after 0800 on 8 
December — 7 December on the other side of the Inter- 
national Date Line — when Japanese bombers unloaded 
their deadly cargoes over the defense facilities of Apra 
Harbor. The following day three air attacks took place, 
the last described by the military governor, CAPT 
George McMillin, USN, in his last message: "Last at- 
tack on Agana. Civilians machine-gunned in streets. 
Two native wards of hospital and hospital compound 
machine-gunned . . ."(2) 

The American defenders, 400 naval personnel and 
155 Marines, were no match for the Japanese invaders. 
For Leona Jackson, of the Navy Nurse Corps, the 

U.S. Navy Medicine 

bitterest moment of her life "... came at sunrise [on 
the 10th] when, standing in the door of the hospital 
library, I saw the Rising Sun ascend the flagpole where 
the day before the Stars and Stripes had proudly 
flown. "(3) 

For Chief Pharmacist's Mate Adolph Wessel Meyers 
and other members of the hospital staff there would be 
many bitter moments; at 0550 their long, painful ordeal 
as prisoners of war began. 

10 December 1941 

. . . Buried 14 dead shortly after capture. All Ameri- 
can and native nurses work in Ward II. Japs took over 
remainder of hospital . . . 

The suddenness and ferocity of the Japanese attack 
had dazed the survivors, yet the medical personnel 
continued to treat the badly injured casualties. 

For the next three weeks the Japanese allowed the 
Americans to continue treating patients. Then, self- 
rule suddenly came to an end. After being forced by 
their captors to witness a victory parade, the prisoners 
were herded aboard a Japanese merchant vessel for a 
four-day trip to Japan. The first stop was a hastily con- 
structed POW camp on the island of Shikoku. 


The 400-500 Americans were ill prepared for what 
awaited them. As they disembarked in the remnants of 
their tropical uniforms, they shivered in the frigid air. 
Many were surprised to find what kind of winter Japan 
really had. 

The Japanese had built Zentsuji camp at the base of a 
steep mountainside about five miles inland from the 
port of Tadotsu on the northern coast of Shikoku. Living 
quarters were unpainted frame structures and unfortu- 
nately, too well ventilated. Many of the walls had large 
gaping cracks which allowed the wind to whistle 
through unhindered. 

Sleep for the weary prisoners came hard. Flimsy, 
raised wooden platforms covered with filthy straw mats 
offered little insulation either from the cold or the 
hoards of rats that noisely carried on their nocturnal 
activities beneath. Pillows were bags of light canvas 
filled with rice hulls. 

Each building housed from 24 to 125 men. Charcoal- 
fueled hibachis, one to a building, provided the only 
heat, but more often the men had to pull their vermin- 
infested blankets over their heads to keep warm. 

Yet for all its shortcomings, Zentsuji was a model 
camp, and for propaganda purposes, photographers 
were initially allowed to wander about to see how well 
Japan treated her prisoners of war. (4) 

A wing of the U.S. Naval Hospital in Agana. Guam as it appeared on 10 December 1941, the day Meyers was captured. 
Volume 70, September 1979 13 

The camps 

27 February 1942 

Oesa Yama working party started. 

The Americans were not long at Zentsuji before the 
Japanese began organizing work parties. Oesa Yama 
was a land reclamation project about three miles from 
the camp. Because arable land was always at a 
premium in Japan, the Japanese decided to terrace a 
mountainside by having prisoners remove large rocks 
and boulders. 


The work day was from five to eight hours long with 
Sunday a rest day. The men carried their food with 
them in mess kits and were given hot tea to drink. Later 
as they became more accustomed to the strenuous 
work, more was expected of them. The guards meas- 
ured off a certain area for each work detail to dig and 
clear of rocks. They could not return to camp until they 
had completed their quota. It later turned out that this 
work project was easier than most. 

Other prisoners were chosen for stevedore work and 
sent to Osaka to work on the docks. The Japanese 
forced some to work at a railroad station near Zentsuji 
loading and unloading freight cars. 

U.S. Navy Medicine 

17 May 1942 

Had my first banana — wonderful. 

Men, accustomed to wholesome Western food in 
large quantities, were in for another surprise. The typi- 
cal Japanese civilian diet was spartan, consisting 
mainly of rice and vegetables. Prison chow was another 
story. The limited quantity of rice was sometimes aug- 
mented by a soup made of bones and putrid fish scraps. 
Infrequently, the prisoners ate vegetables, fruits, soy- 
bean milk, and very rarely an egg. The rice usually 
came mixed with barley, wheat, beans, tough corn, or 

Bones, taken from the soup, were rotated among the 
messes and after the men had stripped what they could, 
the bleached remnants were returned to the galley to be 
counted and saved for the next meal. 

Although an American was in charge of the mess, a 
Japanese mess sergeant supervised the distribution. 
Rice was rationed by a certain number of grams per 
individual, depending upon whether he was an officer, 
heavy worker, or camp detail POW. Those performing 
heavy labor got more to eat. 

Sanitary conditions in this and other camps were 
frightful. Latrines were straddle trenches enclosed in a 
row of small closets. Each closet was about one and 
one-half yards long by one yard wide with an opening in 
the floor. Each individual carried his own toilet paper 
when it was available. The odor from the latrines per- 
meated every building in the camp. 

27 March 1942 

16 cases of Dysentery in camp. 

Not surprisingly, the harsh prison environment and 
poor nutrition soon turned prisoners into patients. And 
there were many. By now the original contingent from 
Guam had swelled as America's fortunes in the Pacific 
continued to suffer. Chief Meyers and his colleagues 
had much to keep them busy. 

Before leaving Guam, he and the other medical per- 
sonnel concealed various instruments and medicines in 
their luggage. What the Japanese had not confiscated 
they used in treating the prisoners. 

An American doctor conducted sick call twice daily in 
a small dressing room equipped with a table and a 
limited supply of Japanese medical equipment. A 
single faucet provided the only source of water. When 

Volume 70, September 1979 

turned on, a cold trickle flowed onto the concrete floor. 
The corpsmen kept a weak disinfectant solution in small 
quantities in a pan resembling a basin. Warm water 
was unavailable. 

A small ward nearby housed about 12 to 15 patients 
whose beds were on a platform about two feet from the 
floor. This platform was covered with a thin straw mat 
and a canvas covered straw mattress. There were no 
sheets. Flea-infested blankets lay upon the mattresses. 

A hibachi stood in the center of the ward upon which 
they could heat tea and water. Later a coal stove re- 
placed the hibachi but there was rarely enough coal to 
keep it going except for very short intervals. 

28 May 1942 

Attended lecture on Merchant Marine by Ensign 
Wood. Signed pledge not to escape. 

Even with the grueling work details at Zentsuji, there 
seemed to be enough time for prisoners to contemplate 
their situation and long for deliverance. Maintaining 
morale was not easy, but the camp's American officers 
tried to maintain military discipline. They organized 
classes and lectures on a myriad of subjects: hygiene, 
bookkeeping, math, salesmanship, the characteristics 
of motor oil, travel experiences in Central America, and 
many others. "Sing songs" and talent shows became 
quite popular. 

Signing escape pledges were not seen as disloyal 
acts. The idea of escape from Zentsuji or any other 
camp in Japan for that matter was ludicrous. Western- 
ers could hardly blend into the civilian population. 
Those who refused to sign were locked up and put on 
short rations. In return for the pledge, prison officials 
allowed the prisoners to take supervised walks through 
the nearby hills and mountains. They could also play 
catch and cricket on rare occasions. 

31 October 1942 

2 more carloads Red Cross supplies brought in — was 
rec'd in Japan 8-2-42. Rumored there will be no more 
milk because many wounded [Japanese] soldiers re- 
turned here and need the milk. What will our 3 wks old 
puppy, Optimo do? 

The prisoners looked forward to Red Cross shipments 
and parcels from home, but such treats were few and 
far between. Japanese guards opened packages, con- 




After months of waiting, Mrs. 
Adolph Wessel Meyers, 6204 Makee 
avenue, has received a letter from 
her husband held a prisoner of 
war by the Japanese at Osaka pri- 
son camp. This was the first word 
that had come from Chief Phar- 
macist's Mate Meyers since Octo- 
ber. 1943. 

The letter was dated July 31, 
1943, taking more than a year to 
reach here. In it Meyers stated 
he was doing medical work and 
getting along as well as could be 
expected under the circumstances, 
and said he was fervently praying 
to be able to join his family and 
is patiently looking forward to a 
glorious reunion, 

Meyers has been in the U. S. 
navy for 19 years. He was for- 
merly stationed at the naval hos- 
pital at Guam and has not seen 
his family for about four years. 



This week a letter was received 
by Mrs. A, W. Meyers. 6204 Ma- 
kee avenue, from her husband 
Adolph Wessel Meyers, a war pris- 
oner of the Japanese, describing 
bis treatment at the bands of Nip 

Meyers, a navy warrant officer, 
was captured while stationed at the 
naval hospital in Guam and has 
been at Zentsuji war prison camp 

in Japan since Jan. 10, 1942, He is 
38 years of age and has been in 
the navy 18 years. 

It took nine months for the lat- 
est letter to reach Mrs. Meyers 
and was not as encouraging as one 
received in early September of last 

Meyers stated he was doing med- 
ical work in the camp while most 
of the other prisoners were work- 
ing the soil for cultivation, their 
only recreation being a short hike 
once a week, under guard, to 
break the monotony. 

He said he could not get used 
to the food and now weighed only 
112 pounds. His former weight was 
145 pounds. He added that he was 
feeling reasonably well. 


It was wonderful news for Mrs. 
Wessel Meyers of 6204 Makee ave- 
nue, when she learned her husband 
is alive and well, having been a 
captive of the Japs for 3',2 years. 

This news reached Mrs, Wessell 
through the Red Cross, at which 
time she was also told that she may 
correspond with him, until his re- 
turn to the states. It is expected 
that he will be flown to San Fran- 
cisco in the near future. 

The last word Mrs, Meyers had 
from her husband was last spring, 
when he said he had received pic- 
tures of her and their three child- 
ren, Wessel Jr., 17, Betty Lou 16. 
and Billy 5. Since that time and up 
to the world from the Red Cross, 
Mrs. Meyers had no further com- 
munication from him. 

Meyers is a chief pharmacists mate 
and has been away from home for 
the past 4'b years. Udoh his arrival 
he will find that Wessell Jr. has 
joined the navy too, and is stationed 
at San Diego. 

Clippings from a wartime Los Angeles paper tell of Meyers' imprisonment. 


It was just announced this week 
by the War Department that Chief 
Pharmacist's Mate, Adolph Wessel 
Meyers, U. S. Navy, has been re- 
leased from a Japanese prison camp 
at Osaka. 

Meyers was captured on December 
10, 1941, while stationed at the hos- 
pital on the island of Guam, His 
family has not seen him for four and 
a half years. The Meyers have three 
children, Billy, 5, who has not seen 
his dad since he was five months 
old, and who now attends kindergar- 
ten at Miramonte school; Betty Lou, 
16, and Wessel, 17, now in boot 
training at San Diego", Naval training 

Letters have been received from 
friends who have talked to former 
prisoners, telling glaring accounts of 
Meyer's actions, keeping Japs away 
from sick fellow prisoners. One told 
of the many lives he had saved due 
to his wonderful care, where he did 
medical work at the Osaka hospital 
for prisoners of war. 


U.S. Navy Medicine 

fiscated razor blades, games, pencils, and other 
personal items, ate whatever candy they found, and cut 
up bars of soap, ostensibly looking for hidden mes- 

28 August 1942 

At last letters received [from] Betsy, Dorothy and Mary 

Katherine — Am wonderfully happy. 

The Japanese allowed each prisoner to write one 
letter every five or six months and limited each to 300 
words. There was a prescribed format. They could 
mention certain things such as receipt of mail from 
home, how they missed their folks, request certain 
items except for food, and write about very general 
topics. They could not mention work, the location of the 
camp, their health — unless it was good — and how they 
were being treated unless that too was favorable. 
Usually about 20 incoming letters were doled out each 
day after being censored. 

8 January 1943 

It is rumored that 50 men including 2 Chiefs will soon 
leave for parts unknown. I am one of the Chiefs. 

What awaited Chief Meyers and his comrades was 
far worse from what they had ever known at Zentsuji. 

Tanagawa Death Camp 

13 January 1943 

Arr. Osaka 0500— Short trolley ride. 0715 boarded 
elec train and arr Tanagawa 0815. Was in charge of 
party. Assigned to Med. duty. 2 Army medicos here. 
Prison number 508. Living in Bks III. Epidemic of diar- 
rhea. In charge of Bk II; 70 sick there. 

The 50 men arrived on the outskirts of Osaka after a 
trip by boat and train. Guards ordered Chief Meyers to 
select those unable to walk the distance of four or five 
miles to the camp and have them ride in a dump truck. 
As the rest marched along the road under guard they 
heard strange American voices from the various work 
projects shouting "You'll be sorry." When they arrived 
at Tanagawa, they realized what the voices meant. 

Meyers was shocked and revolted by what he saw. 

The camp's inhabitants were Army, Navy, and Marine 
prisoners that had already lived through the horrors of 
Corregidor and Bataan. They had arrived in Japan in 
poor health yet had been forced to work through the 
winter with inadequate clothing and poor food. Their 
ration was the absolute minimum and the men were 
dying at about the rate of one a day. Out of the original 
454 officers and men in the camp from the Philippines, 
about 100 had died, principally from dysentery brought 
on by the abominable sanitary conditions. The others 
were suffering from malaria, dengue fever, diarrhea, 
and beriberi. 

Meyers took over the hospital, a building in which 
100 patients were crowded in the most unspeakably 
filthy conditions. He did not understate the situation 
when he added a note to his diary: "Morale here is very 
low. All these men are from the Philippines and have 
gone thru most horrible experiences . . . some are quite 
ill mentally." During that first month at Tanagawa he 
could do little but watch helplessly as 19 more victims 
succumbed to pneumonia, dysentery, or malnutrition. 

Besides the many illnesses, Meyers found the camp 
crawling with lice which the prisoners had picked up 
enroute from the Philippines. Due to a shortage of fuel 
and caldrons to boil the camp clothing, it took nearly 
two months to rid the camp of the vermin. 

His first priority was securing medicine; Tanagawa 
had few medical supplies. A barracks stood adjacent to 
the hospital. In it about 25 to 35 men convalesced from 
weakness and illness which the Japanese considered of 
a minor nature. In the prison administration building 
was a small closet-like room called the "Death House." 
Here there was space for about eight patients whose 
condition was so critical that survival seemed beyond 
hope. Next door, in a little medical office, the Japanese 
made out their medical reports and issued small 
quantities of what scant medicine was available. 

The Americans held sick call in the cramped hallway 
of the Japanese administration building. There were no 
tables. Two benches had to suffice for dressings and 

Chief Meyers and his colleagues found it necessary 
to practice stringent conservation. They washed and 
rewashed gauze or bandage material and used it on the 
various wounds until it disintegrated. After a patient's 
treatment was completed, he was instructed to scrub 
his dressings so they could be reused. No sterilization 
equipment existed at Tanagawa. 

For the remainder of that winter of 1 943 and into the 
spring, Meyers worked day and night scrounging 
medicine and treating the sick. One survivor estimated 
that he alone saved the lives of at least 25 men. No one 
could imagine from where he drew his strength. 

Volume 70, September 1979 


6 May 1943 

Went to Fuke with Masaki, bought much medicine; 
had apple and soda. 

The contents of Chief Meyers' medical kit. Two of the instruments were made by prison inmates — the spear-shaped scalpel 
ground from a dental spatula, and the probe just below it made from a spring. 

seemed more bereaved than the Americans them- 

Around the middle of March 1943, the Japanese 
moved the Chief and his patients to a new barracks 
fitted out as a hospital. It was a vast improvement over 
the old lodgings and more medical supplies were avail- 
able. The Japanese closed the "Death House" and 
morale and health suddenly began to improve. 

The quality of life in Japanese captivity could rapidly 
go from bad to worse as the prisoners quickly learned. 
No sooner had the patients settled into their new 
medical barracks than rumors began to fly that they 
would be shipped to another prison. A mood of appre- 
hension and forboding settled over the camp. 

(To be concluded in the October issue) 

Suddenly, the hard work and the pleading began to 
pay off. A Japanese sergeant and his assistant in 
charge of medical facilities had always shown sympathy 
toward the prisoners, particularly the sick and injured. 
Meyers persuaded the two men that more would need- 
lessly die without medicine. They took the Chief to town 
several times and made the rounds of the local drug 
stores, buying medicines the sergeant paid for out of 
his own pocket. They were able to procure vitamin 
tablets and, most importantly, magnesium sulphate or 
Epsom salts. Meyers soon discovered that this drug, 
when administered properly, would cure diarrhea. The 
Chief owed much to his two Japanese friends. In a 
camp where brutality against Americans was common- 
place, their concern was nothing less than phenomenal. 
When any of the prisoners died, Sergeant Hyashi 


1 . Karig, Walter, et al., Battle Report: Pearl Harbor to Coral Sea, 

2. ibid. 108. 

3. ibid. 109. 

4. Marek, Stephen. Laughter in Hell: Being the True Experiences 
o/LTE.l. Guirey (USN) and TSGT H.C. Nixon (USMQ and Their 
Comrades in the Japanese Prison Camps in Osaka and Tsuruga, 14. 


U.S. Navy Medicine 


A Qualitative and Quantitative Drug 
Use Review: Cephalosporins and 

LT Ron E. Whiten, MSC, USNR 

In October 1977, the Committee on Nosocomial Infec- 
tions at NRMC Portsmouth, Va., began a prospective 
review on the utilization of intravenous cephalosporins 
and aminoglycosides. Three cephalosporins (cepha- 
lothin, cefazolin, and cephapirin) with four aminoglyso- 
sides (gentamicin, tobramycin, amikacin, fcanamycin) 
were studied. The purpose of the review was to collect, 
organize, analyze, and report information on the ration- 
ality of drug usage. 


The pharmacist in the Intravenous Admixture Room 
recorded the name and hospital identification number 
of all patients receiving cephalosporins and aminogly- 
cosides during the month of October 1977. 

The Medical Audit Assistant of the Medical Records 
Branch reviewed the patients' charts and recorded the 
clinical information required to evaluate the quality of 
care. Diary entries included: 

• patient's name, 

• hospital registry number, 

• age, 

• sex, 

• admission date, 

• discharge date, 

• drug used, 

• dosage, 

• date ordered, 

LT Whiten is a clinical pharmacist with the Pharmacy Service at 
NRMC Portsmouth, Va. 23708. 

The author thanks CDR Gary W. Watson, MC, USN, Head Infec- 
tious Disease Division; LCDR Bob Thompson, MSC, USN, Clinical 
Pharmacist; and Mrs. Liz Reid, Medical Audit Assistant, for their as- 
sistance in preparing this report. 

Volume 70, September 1979 

• date discontinued, 

• site of infection, 

• class of infection, 

• culture and sensitivity, and 

• laboratory management of aminoglycosides. 

The indication for use of the antibiotic was noted as: 
(1) Nosocomial (site of infection was related to a surgi- 
cal procedure or mention of the infection being 
nosocomial was made in the chart); (2) Prophylaxis (an 
attempt was being made to prevent infection when 
there was no evidence of infection at start of treat- 
ment); (3) Unknown (no definite site of infection was 
recognized or statement that the medication was being 
used prophylactically); and (4) Community Acquired 
(infection acquired prior to admission). 

Laboratory management for aminoglycosides was 
subdivided into: 

• Blood Urea Nitrogen (BUN) or creatinine ordered 
prior to start of antibiotic, and 

• followup for BUN or creatinine at least every three 

An audit board or Professional Standards Review 
Organization (PSRO) reviewed only the completed 
chart, as did the Joint Commission on Accreditation of 
Hospitals (JCAH). All completed charts were sent to 
Medical Records Branch upon discharge of the patient 
and, hence, the medical audit assistant became the key 
individual in recording clinical data. Parameters were 
explicit and required minimum interpretation. The 
period of time involved was longer than anticipated as 
one patient was not discharged until 24 March 1978; 
therefore, the Medical Records Branch was not able to 
complete its report until April 1978. The clinical phar- 
macist interpreted the data and reported his findings to 
the committee meeting in July 1978. 



A total of 60 patients participated in the study — 27 
male and 33 female. Cephalothin was administered to 
42 patients, cefazolin to 4 patients, gentamicin to 26 
patients, amikacin to 1 patient, and combination of 
cephalothin and gentamicin to 12 patients. Cephapirin, 
tobramycin, and kanamycin were available but were not 
prescribed during the period studied. Other parenteral 
antibiotics may have been used concomitantly but were 
not included in this study. 


Thirty-three patients were identified as receiving a 
parenteral cephalosporin — 15 male and 18 female. 
Hospitalization ranged from 4 to 76 days with an aver- 
age stay of 14.85 days. The most frequently prescribed 
cephalosporin was cephalothin administered as one 
gram every six hours {16 patients) and two grams every 
six hours (5 patients). Cefazolin was prescribed for four 
patients; one patient received 500 mg every six hours 
and three got 500 mg every eight hours. It was noted 
that one patient initially received cephalothin for two 
days and then the order was changed to cefazolin for 
two days. 

Duration of therapy (Table 1) ranged from one dose 
to 22 days of continuous therapy with an average ther- 
apy period of 6 days. 

The sites of infection were compiled into anatomical 
categories where two or more cases were documented 
(Table 2). It was noted that 15 cases, or 45.5 percent, 
had no documentation as to site of infection. 

Prophylaxis was recorded (Table 3) as the primary 
use (48.5 percent) of the cephalosporins. Some of the 
indications classed as "unknown" may also have been 
actually used prophylactically. 

On performing appropriate cultures and sensitivities 
for cephalosporins, some interesting information was 
revealed from the charts. There were 7 cases where the 
culture and sensitivity (C & S) had not been ordered, 5 
reports of "no growth," and 21 cases reporting positive 
growth. Of the 21 positive cultures, only 16 had sensi- 
tivities documented in the patients' records. In the five 
cases where "no growth" had been reported, the 
antibiotic had been properly discontinued. 


Fifteen patients received an aminoglycoside as an 
intravenous antibiotic — 4 male and 11 female. Hos- 
pitalization ranged from 3 to 24 days with an average of 
10.33 days. Twelve of the 15 patients received the 
dosage of 80 mg every eight hours. 

The average length of therapy was 6.3 days with a | 

TABLE 1. Duration of Therapy for Cephalosporins 

Less than five days 
Five to ten days 
Greater than ten days 

22 patients 
6 patients 
5 patients 

range of one dose to ten days. Data on duration of 
therapy, sites of infection, and indications for use of the 
aminoglycosides are given in Table 4. 

Of the patients receiving aminoglycosides, there 
were two reports of "no growth," and only one chart 
did not have documentation of a C & S. In the 12 
positive cultures, four patients did not have reports of a 
sensitivity and one report recorded resistance to 
gentamicin. The patient with the resistant strain had a 
nosocomial infection of the vaginal cuff and the medica- 
tion was continued. 

As to monitoring the potential nephrotoxicity of pa- 
tients on aminoglycosides, all 15 patients had had a 
BUN or creatinine ordered prior to starting therapy. 
Twelve cases fell within our dictated followup of a re- 
peat BUN or creatinine every third day. One case had 
repeat lab work about every fourth or fifth day. Another 
case had not had a BUN or creatinine ordered since 
admission (received gentamicin for five days). A third 
case had six days of therapy with lab work after com- 
mencing therapy. 


Site of Infection 

No documentation 

15 cases 

Skin wounds 

5 cases 


3 cases 

Urinary tract 

3 cases 


7 cases 

TABLE 3. Indications for Use 


16 cases 

10 cases 

6 cases 

1 case 

U.S. Navy Medicine 

Cephalosporins and Aminoglycosides 

There were 12 patients who received a cephalosporin 
and an aminoglycoside during their hospitalization. 
Age range in this group was 5 years to 71 years with 
seven male and five female patients. Length of hos- 
pitalization ranged from 6 to 150 days. 

Six patients were started on both a cephalosporin and 
an aminoglycoside and continued on both drugs 
throughout their therapy. Four of the six patients were 
reported to have nosocomial infections and two of the 
infections were categorized as unknown. Table 5 gives 
data on sites of infection and indications for use. 

In the 12 patients treated with the combination of a 
cephalosporin and an aminoglycoside, all but one case 
received the products cephalothin and gentamicin for 
the duration of their therapy. The exception was a pa- 
tient with a nosocomial infection who had received 
seven days of therapy with amikacin after receiving six 
days of gentamicin. This patient also received 23 days 
of cephalothin. 

As to the C & S, only one patient had a report of "no 
growth" and the medication was discontinued upon 
receipt of the lab report. 


In the study 33 patients were treated with a paren- 
teral cephalosporin, and 12 additional patients received 
both a cephalosporin and an aminoglycoside. Cepha- 
lothin was the most frequently prescribed cephalo- 
sporin at a dosage of one gram every six hours. The 
primary use for the cephalosporins was prophylaxis 
(48.5 percent). In 45.5 percent of the cases reviewed, 
the site of infection was not documented in the chart. 
Only 67 percent of the patients' charts contained a 
report of a positive culture, and 67 percent received a 
cephalosporin for less than five days. A total of 1,301 
grams of cephalothin and 33.5 grams of cefazolin were 
used in the study. 

Fifteen patients received parenteral aminoglycosides 
as their single antibiotic; of the four available on the 
formulary, gentamicin was most frequently ordered 
using the dosage of 80 mg every eight hours. 

Infection located in the pelvic area constituted 53.3 
percent of the gentamicin used. The class of infection 
was equally divided between nosocomial, prophylaxis, 
and unknown. On the followup of BUN and creatinine 
laboratory work, 80 percent of the cases reviewed met 
the protocol standard of obtaining the lab work every 
three days, and 93.3 percent had had a BUN or 
creatinine ordered during the therapy period. A total of 
38.8 grams of gentamicin was used. 

TABLE 4. Aminoglycosides 

Duration of Therapy 

Less than five days 7 cases 

Five days or greater 8 cases 

Site of Infection 

Pelvic 8 cases 

Abdominal 3 cases 

No documentation 1 case 

Other 3 cases 

Indication for Use 

Nosocomial 5 cases 

Prophylaxis 5 cases 

Unknown 5 cases 

TABLE 5. Data 

Sites of Infection 


4 cases 


2 cases 


2 cases 

Not documented 

1 case 


3 cases 

Indication for Use 


6 cases 


6 cases 


We were able to identify specific deficiences in pre- 
scribing habits of practitioners. Due to the lack of 
proper documentation and scarcity of notes, we were 
unable to properly monitor the drug therapy to deter- 
mine the physicians' thoughts by our parameters. 
Many of the charts where the indications for use had 
been classified as unknown may have really been 
prophylaxis in nature. 

However, merely recording less than ideal prescrib- 
ing practices does not guarantee changes in the 
prescribing patterns. It would seem much better to 
promote rational drug therapy by education of physi- 
cians. By tradition this is carried out through consulta- 
tions and formal teaching rounds. The efficacy of these 
methods in promoting rational antibiotic therapy would 
seem obvious, but it remains largerly unproven. 

Whether the changes in prescribing patterns brought 
about by review of drug usage are transient or perma- 
nent remains to be seen. 

Volume 70, September 1979 


Temporal Lobe Seizures Simulating 
Anxiety Attacks 

CDR Jesse O. Cavenar, Jr., MC, USNR-R 
CAPT Michael A. Harris, MC, USN 

Anxiety manifests itself clinically in many patterns, 
ranging from the bound anxiety of some psychosomatic 
disorders to the free-floating anxiety attacks that are 
frequently seen in medical practice. According to 
French (J) "morbid anxiety, which is unwarranted by 
the real situation, is the commonest psychiatric symp- 
tom." Anxiety is so prevalent that many physicians do 
not consider it difficult to diagnose with accuracy. Yet, 
many conditions, both psychogenic and physical, can 
simulate acute anxiety attacks. Most experienced clini- 
cians have had cases in which a patient was initially 
thought to have straightforward anxiety attacks, and 
was later discovered to have Grave's disease, diabetes 
mellitus, a progressive central nervous system disease 
resulting in a tremor, or some other significant physical 
problem which was subsequently diagnosed. 

The purpose of this case report is to again alert the 
clinician to the fact that the most common of psychiatric 
symptoms may be most difficult to diagnose. 

Case Report 

A 19-year-old single white male sailor sought psy- 
chiatric consultation because of a six-year history of 
recurring episodes characterized by anxiety, a feeling 
of tightness in the throat, and recalling past events. 
These episodes occurred as frequently as three or four 
times per day, or as infrequently as once a month. The 

Dr. Cavenar is chief of psychiatry at the Veterans Administration 
Hospital, and professor of psychiatry at Duke University School of 
Medicine, Durham. N.C. 27705. 

Dr. Harris is with the Psychiatry Service at NRMC Charleston, S.C. 


frequency and severity of the attacks had increased 
over the past 6 to 12 months, and had become associ- 
ated with nausea and a mild headache. The past events 
which he would recall were not consistently good or 
bad, and were not a single memory or memories which 
recurred repeatedly. These attacks might appear at any 
time, under any circumstances, and could not be re- 
lated to a particular situation. 

His past history was characterized by multiple 
traumas. The mother had abandoned the family follow- 
ing the father's sudden death of a myocardial infarction 
when the patient was 12. The patient had then lived 
with two different foster families between ages 13 and 
17, finally quitting school in the 10th grade, despite 
good grades, because of friction and dissatisfaction 
with the foster parents. He had then entered military 
service; his military record indicated a dismal 
performance due to disinterest, defective attitude, 
authority conflicts, and a persistent need for close 

The mental status examination revealed a coopera- 
tive, almost obsequious, young man who was in no dis- 
cernable distress. He was alert and oriented with ap- 
propriate affect. There was no evidence of thought dis- 
order or psychosis, and no vegetative signs of depres- 
sion. He denied alcohol or illicit drug use, and there 
were no clinical signs of organic brain syndrome. 

The initial impression was that the patient was ex- 
periencing mild to moderate anxiety attacks when 
repression failed, permitting conflict- laden traumata 
from his past to become conscious. This view was sup- 
ported by the fact that these attacks had started at the 
time when he had lost both parents and was living with 
foster families. 

U.S. Navy Medicine 

A Minnesota Multiphasic Personality Inventory was 
administered. The results appeared valid, and were 
suggestive of paranoid schizophrenia. The possibility of 
a neurotic reaction or organic brain syndrome was also 
raised. Due primarily to the discrepancy between the 
clinical evaluation and the test results, neurological 
consultation was requested. 

The neurological evaluation noted a normal physical 
examination. Skull films were normal, cranial nerves 
were intact, and motor, power, tone, gait, and co- 
ordination were all normal. An electroencephalogram 
showed brief runs of left temporal four to six Hertz 
slowing enhanced during hyperventilation. In addition, 
there were brief, generalized, irregular complex 
paroxysmal discharges without clinical accompaniment. 
These findings were considered to be epileptogenic, 
and the patient was begun on Tegretol 200 mg twice 
daily. His symptoms totally disappeared on this medi- 
cation regimen. 


Intense emotional experiences may occur in temporal 
lobe seizures. Most common is fear or anxiety. (2) This 
feeling may be accompanied by epigastric distress and 
a choking, tight feeling in the throat, at times so intense 
that the patient fears he is dying. These sensations may 
be accompanied by autonomic phenomena, such as 
tachycardia, dilated pupils, sweating, and hypoten- 
sion. (3) Fox, et al(4) have described such autonomic 
events responding to anticonvulsant medication even in 
the absence of clinical evidence of seizure disorder. 

Cole and Zangwill(5) have noted that the classic feel- 
ing of deja vu that may be experienced during temporal 
lobe seizures is often indescribable by the patient. The 
feeling is most often a sense of familiarity, of the event 
having happened previously. This feeling may be asso- 
ciated with auditory or visual hallucinations; at times 
the patient cannot recall what the memory was, and 
knows it only as something familiar. Most commonly, 
the same sequence of events or memories is repeated in 
each seizure discharge. 

Daly (6) states that olfactory and gustatory hallucina- 
tions are frequent in temporal lobe seizures, but are not 
always present. The hallucinations characteristically 
are unpleasant sensations such as burning onions, 
burnt rubber, or equally noxious stimuli. 

Currie, et al(7) reported on 666 patients who had 
clinical features of temporal lobe seizures. The EEG 
was definitely abnormal in 92 percent of the patients. 

Volume 70, September 1979 

Of their cases, the temporal lobe seizures began under 
the age of 10 in 12 percent, between 10 and 15 in 14 
percent, between 15 and 25 in 23 percent, between 25 
and 45 in 32 percent, and over 45 years of age in 19 

Feindel and Penfield(#) state that 75 percent of pa- 
tients with temporal lobe seizures will have periods of 
automatic behavior either during or following the 
seizure. Simple automatisms may include lip- smacking, 
chewing, or motions of the hands, while complex 
automatisms such as undressing, wondering about, or 
running are less commonly seen. Knox (9) notes that 
automations are brief, lasting less than five minutes in 
80 percent of cases. 

Clearly, if a patient presents with many of the above 
noted typical symptoms, and is a relatively good histo- 
rian, the diagnosis of temporal lobe seizures poses little 
problem. When the symptoms are less well defined, as 
in this case, it may be extremely difficult to make the 
correct diagnosis. Given the multiple manifestations 
and the various clinical presentations of anxiety, one 
can only wonder how many patients, particularly those 
who are poor historians, are diagnosed as suffering 
from anxiety when in fact they are experiencing partial 
seizures. In this case, it was only an incongruity in 
findings which led to a neurological evaluation and 
proper diagnosis and treatment. We suggest that the 
clinician should consider the possibility of partial 
seizures in any patient who presents with "anxiety" 
which in any way appears to be atypical. 


1. French's Index of Differential Diagnosis. Douthwaite AH, ed. 
Williams and Wilfcins Co., Baltimore, 1967, p 85. 

2. Macrae D: Isolated Fear: A Temporal Lobe Aura. Neurology 4: 
497-500, 1954. 

3. Van Buren JM, Ajmone-Marsen C: Correlation of Autonomic 
and EEG Components in Temporal Lobe Epilepsy. Arch Neurol 3: 
683-703, 1960. 

4. Fox RH, et al: Spontaneous Periodic Hypothermia: Dience- 
phalic Epilepsy. Br Med J 2:693-695, 1973. 

5. Cole M, Zangwill OL: Deja Vu in Temporal Lobe Epilepsy. J 
Neurol Neurosurg Psychiat 26:37-38, 1973. 

6. Daly DD: Uncinate Fits. Neurology 8:250-255, 1958. 

7. Currie S, Heathfield KWG, Henson RA, Scott DF: Clinical 
Course and Prognosis of Temporal Lobe Epilepsy. A Survey of 666 
Patients. Brain 94:173-190, 1971. 

8. Feindel W, Penfield W: Localization of Discharge in Temporal 
Lobe Automatism. Arch Neurol Psychiat 72:603-630, 1954. 

9. Kox SJ: Epileptic Automatism and Violence. Medical Science 
and Law 8:96-104, 1968. 


How I Manage the Patient 
With Urethral Discharge 

CDR Gordon R, MacDonald, Jr., MC, USNR 

Urethral discharge is a frequent complaint in military 
and civilian clinics. I have observed that it often pre- 
sents a diagnostic and therapeutic dilemma for the 
physician and, not infrequently, is treated inappropri- 
ately. This potentially results in increased morbidity 
and unnecessary concern to the patient. 

There are three main causes of urethral discharge. 
The first is gonococcal urethritis. This usually presents 
as a thick, often copious, purulent discharge which 
occurs throughout the day, and frequently stains the 
underwear. The discharge may even have a greenish 
color. There is often a history of sexual contact, and as- 
sociated dysuria and pyuria. A urine culture for 
standard pathogens will be negative; however, a 
urethral culture and smear will be positive for gonor- 

The second cause for urethral discharge is "non- 
specific" urethritis. As the name implies this is urethri- 
tis caused by organisms "other than gonorrhea." 
Recent work has shown that Chlamydia or Mycoplasma 
may be isolated in approximately 50 percent of these 
cases, (1,2) although a causative role has not been 
definitely established. The standard clinical bacteriol- 
ogy laboratory does not have the capability to detect 
these organisms at present and, therefore, the urine 
culture, urethral culture, and gram stain will be nega- 
tive or disclose contaminants. The discharge usually is 
less copious, and less purulent than that associated 
with gonorrhea. There may be dysuria and pyuria but 

From NRMC Charleston, S.C. 29408, 

these also are less intense than with gonorrhea. 

The third cause of urethral discharge may be the 
most common and yet the most confusing condition 
seen. The patient notes a drop or two of a thin, watery, 
mucoid discharge, seen usually in the morning on first 
arising or during a bowel movement. It may appear 
with sexual stimulation or the patient may volunteer 
that it appears only if he "milks" his urethra. There 
may be no history of recent sexual contact and the pa- 
tient may have had previous courses of antibiotics only 
to have the problem recur. The discharge is scanty, 
rarely causing significant staining of underwear. The 
urinalysis, urine culture, urethral swab culture, and 
smear are all negative. There may be a history of sexual 
abstinence or of recent increased sexual activity. The 
patient may also complain of vague perineal or testicu- 
lar aching. 

This syndrome is due to the normal release of secre- 
tions of the accessory sexual glands of which the 
prostate is the most important. If the patient has been 
"milking" his urethra, this irritation alone will produce 
a watery discharge given enough time. Military men 
are likely to develop these complaints during a tour that 
separates them from their spouse or shortly after return 
from such a tour when sexual activity may be increased. 
The best name for this condition is the Prostatic Con- 
gestion Syndrome or Prostates is. The diagnosis of 
chronic prostatitis is inappropriate for this condition as 
it implies an infectious cause and need for antibiotics. I 
reserve the term chronic prostatitis for chronic bacterial 
infection of the prostate. I admit that chronic prostatitis 
may also cause a discharge, but its character is not thin 
and watery, there is usually associated pyuria and the 

U.S. Navy Medicine 


Type of 


History of 



Gm, Stain 






Thick Purulent, 

Gm. Neg. 

+ for 


Penicillin + 





N. Gonorrhea 

Probenecid or 












Thin, watery, 



May be 




mucoid, usually 


not helpful — 



in a.m. Patient 
may have to 
milk urethra in 
order to demon- 
strate or note at 
bowel move- 

and reassur- 

urine culture is frequently positive for a usual urinary 
pathogen. There also may be a history of recurrent 
urinary tract infection some of which may have been 
accompanied by fever (acute prostatitis). 

Trichomoniasis and urethral stricture should be 
mentioned as rare causes of urethral discharge. The 
former is diagnosed by a wet prep smear of the 
discharge or by seeing the organism on the urine. 
Stricture should be suspected if there is a history of a 
weak stream, straining to void, and hematuria or 
pyuria. The discharge with either condition is rarely 


The treatment for gonococcal urethritis is as indi- 
cated by the Communicable Disease Center and in- 
cludes either penicillin and probenicid in combination, 
spectinomycin, or tetracycline. 

Tetracycline is probably the best for "nonspecific" 
urethritis as Chlamydia are usually susceptible to this 
antibiotic. (J) 

I do not feel antibiotics are the value in the prostatic 
congestion syndrome, I advise the patient of the factors 

Volume 70, September 1979 

responsible for the discharge and suggest that when he 
resumes sexual activity with regular frequency his dis- 
charge will disappear. I find it also important to em- 
phasize that this is not a contageous disease and that he 
not fear passing it on. 1 remind him that the symptoms 
may return if those factors which acted initially to 
produce the discharge should recur. 

Occasionally, I am able to eliminate gonorrhea, 
Trichomonas, and stricture as causative in a particular 
case, but remain uncertain whether the patient has 
prostatic congestion or nonspecific urethritis. In this 
circumstance, I give a therapeutic trail of tetracycline. 
The discharge of nonspecific urethritis will respond, 
prostatic congestion will not. 


1. Dunlop EMC, Vaughan-Jackson JD, Darougar S, et al: 
Chlamydial Infection: Incidence in "Nonspecific" Urethritis. Br J 
Vener Dis 48:425-428, 1972. 

2. Holmes KK, Handsfield HH, Wang SP, et al: Etiology of Non- 
gonococcal Urethritis. N Engl J Med 292:1199-1205, 1975. 

3. Holmes KK, Johnson DW, Floyd TM: Studies of Venereal 
Disease. III. Double Blind Comparison of Tetracycline Hydrochloride 
and Placebo in Treatment of Urethritis. JAMA 202:474-476, 1967. 


Recent Publications by Navy Authors 

The following are papers published or issued by 
Naval Medical Research Institute military and civil- 
ian investigators at NNMC Bethesda, Md., since the 
beginning of 1979. 

Characterization of the Immunosuppressive State 
During Schistosoma Mansoni Infection by Attallah 
AM, Fleischer T, Scher I, Smith AH, Woody J, 
Ahmed A, Murrell KE, Vannier WE, and Sell KW. 
Journal of Immunology 122(4): 1413- 1420, 1979. 

Induction, Characterization, and Specificity of 
Antirecognition Structure (Idiotype) Antibody in the 
Primate by Sell KW, Goldman MH, Ahmed A, Leap- 
man SB, Strong DM, and Smith AH. Transplantation 
Proceedings ll(l);704-707, 1979. 

Reverse-Phase High-Pressure Liquid Chromatog- 
raphy of Urinary Catecholamine and Related Acidic 
Metabolites in Biological/ Biomedical Applications 
of Liquid Chromatography by Mell LD Jr. New York, 
Marcel Dekker pp 619-639, 1979. 

Navy Biomedical Assessment of I- A TA Systems, 
in Proceedings of the Ninth Annual International 
Diving Symposium by Bachrach AJ and Naquin JC. 
New Orleans, Association of Diving Contractors pp 
181-183, 1979. 

Sensitive Microplate Enzyme-Linked Immuno- 
sorbent Assay for Detection of Antibodies Against 
the Scrub Typhus Rickettsia, Rickettsia Tsutsuga- 
mushi by Dasch GA, Halle S, and Bourgeois AL. 
Journal of Clinical Microbiology 9(l):38-48, 1979. 

Growth of Rickettsia Typhi in Irradiated L Cells 
Enhanced by Lysosomal Stabilization by Woodman 
DR. Weiss E, Schultz WW, and Woodman KL. 
Infection and Immunity 23:61-67, 1979. 

Protective Activity of Antibodies to Exotoxin A 
and Lipoplysaccharide at the Onset of Pseudomonas 
Aeruginosa Septicemia in Man by Pollack M and 
Young LS. Journal of Clinical Investigation 63(2): 
276-286, 1979. 

Induction of Memory Cells in Vitro With an Anti- 
idiotype Serum Against the Recognition Structure 
Specific for Cells Primed for Histocompatibility 
Determinants by Strong DM, Gawith K, Sell KW, 
Ahmed A, Goldman MH, Leapman SB, and Smith 
AH. Transplantation Proceedings 11(1):928-931, 

Kidney Transplantation in the Army Medical De- 
partment by Light JA, Strong DM, Goldman MH, 
Alijani MR, Annable CR, and Wildstein A. Military 
Medicine 144(4):21 7-222, 1979. 

Genetic Requirements for Bone Marrow Trans- 
plantation for Stem-Cell — Defective W/WV Mice by 
Sharkis SJ, Jedrzejczak WW, Cahill R, Sell KW, and 
Ahmed A. Transplantation Proceedings 11(1):511- 
516, 1979. 

Ecology. Serology, and Enterotoxin Production of 
Vibrio Cholerae in Chesapeake Bay by Kaper J, 
Joseph SW, Lockman H, and Colwell RR. Applied 
and Environmental Microbiology 37:91-103, 1979. 

Quantitative Radionuclide Imaging for Early De- 
termination of Fate of Mandibular Bone Grafts by 
Triplett RG, Vieras F, Kelly JF, and Mendenhall 
KG. Journal of Nuclear Medicine 20(4):297-302, 

Species Differences in Decompression by Berg- 
hage TE, David TD, and Dyson CV. Undersea Bio- 
medical Research 6(1):1-14, 1979. 

Should Divers Use Drugs? by Walsh JM. Face- 
plate 10(10):20-23, 1979. 

Electrically Quiet Temperature Controller by 
Yeandle S. Brain Research Bulletin (1): 139-140, 

Cellular Fatty Acid Composition of Vibrio Para- 
haemolyticus by Reversed-Phase High-Performance 
Liquid Chomatography by Mell LD Jr., Joseph SW, 
and Bussell NE. Journal of Liquid Chomatography 
2(3):407-416, 1979. 


U.S. Navy Medicine 



The Department of Extended Programs in Medical 
Education at the University of California School of 
Medicine will sponsor the following courses: 

Neuroradiology 18-20 Oct 1979 

This postgraduate seminar will be held at the Fair- 
mont Hotel, San Francisco, Calif. The program has 
been approved for Category I credit. 

Vascular Disorders and the Primary Care Physician 
19-20 Oct 1979 

A clinically oriented course for primary care physi- 
cians in the diagnosis and management of vascular in- 
sufficiency disorders. Informal brief lectures will be 
supplemented by presentation and discussion of illus- 
trative cases. The main objective is the development of 
clinical perspectives to allow the primary care physician 
to make appropriate diagnostic and therapeutic deci- 
sions. The limitations as well as the potential benefits 
of surgical intervention will be discussed. 

This continuing medical education program meets 
the criteria for 1 1 9b hours in Category I of the Physi- 
cians' Recognition Award of the American Medical As- 
sociation and the Certification Program of the 
California Medical Association, Family Practice credit 
has been applied for. 

World of Family Therapy Symposium 9-11 Nov 1979 

In the past decade, family therapy has grown to 
become a major treatment modality throughout the 
world. In this course, the World of Family Therapy will 
explore the implications of this approach with diverse 
national and international populations. A distinguished 
interdisciplinary faculty of psychologists, psychiatrists, 
and social workers will review recent advances in the 
field, demonstrate their approaches with live or video- 
tape interviews, and provide attendees with an oppor- 
tunity to interact with symposium presenters. The 
course will be of interest to mental health professionals 
experienced in family therapy, as well as those inter- 
ested in exploring it as a treatment modality. 

The program meets the criteria for 10 credit hours in 

Volume 70, September 1979 

Category I of the Physicians' Recognition Award of the 
American Medical Association and the Certification 
Program of the California Medical Association. The 
symposium is also approved by the California Board of 
Registered Nursing for 10 contact hours. 

liquid Chromatography in Clinical Analysis 12-14 Nov 

Liquid chromatography is widely used for the 
monitoring of various classes of therapeutic agents in 
clinical laboratories around the world. This technique is 
rapidly replacing older methods. In addition to its use- 
fulness in the areas of pharmacokinetics and toxicology, 
liquid chromatography is currently being developed for 
the routine analysis of steroids, catecholamines, biliru- 
bins, and a number of other endogenous constituents. 
The main objective of this course will be to acquaint 
clinical pathologists, laboratory directors, clinical 
chemists, and laboratory supervisors with the concepts 
of liquid chromatography and its application to patient 
care. The course will explore current developments in 
liquid chromatography in detail, and will address the 
future potential of this technique. 

The course is accredited for 19 hours of Category I 
AMA/CMA credit. Approval of the course for pharma- 
cists and medical technologists is pending. 

For more information on the above courses, write or 
call: Extended Programs in Medical Education, Univer- 
sity of California, Room 569-U, Third and Parnassus 
Ave., San Francisco, Calif. 94143. Telephone (415) 666- 


The Supercourse® V postgraduate program on lung 
disease sponsored by the American Lung Association of 
Louisiana, Inc., and its medical section, will be held 27 
Nov-1 Dec 1979 at the Hyatt Regency Hotel, New Or- 
leans, La. 

The nationally recognized program consists of (1) 
16th Annual Pulmonary Function in Health and Disease 
Course, (2) 12th Annual Respiratory Disease Course, 
and (3) 9th Annual Pediatric Pulmonary Course. All 
three programs run concurrently and are accredited by 
the American Medical Association in Category I for the 


Physicians' Recognition Award on an hour-for-hour 
basis, and by the American Academy of Family Physi- 
cians for prescribed hours. 

The program content for the three courses covers a 
broad spectrum of lung disease topics. The pulmonary 
function course emphasizes pulmonary function testing 
for the clinician and interpretation of test results, im- 
munology, and patient management. The respiratory 
disease course is primarily a critical care course for the 
physician, nurse, and respiratory therapist. Pediatric 
pulmonary care in the 1980's will be the topic for the 
pediatric program and will cover subjects of practical 
use for the pediatrician and family practitioner 
managing lung disease patients. 

Special luncheon seminars will be offered on a 
limited basis during the program on topics of specific 
interests and specialities. 

The pediatric program will have special sessions for 
nurses and respiratory therapists that will be tailored to 
their respective specialities. 

Tuition for the program will be $225, and includes a 
complete coursebook of the faculty's lectures. For ad- 
ditional information, write: John B. Bobear, M.D., 
Supercourse® V Chairman, American Lung Associa- 
tion of La., Inc., Suite 500, 333 St. Charles Ave., New 
Orleans, La. 70130. 


Many articles by Navy personnel appear each 
year in a variety of professional journals and other 
publications. U.S. Navy Medicine would like to 
include a monthly list of some of these articles 
written by Navy authors from all corps. If you 
have published recently and would like to share 
your research or perceptions with your colleagues, 
please send us the title, name, and issue of the 
publication in which your article appeared. 


The new Nursing Procedures Manual, NAVMED 
P-5066, contains many pages of precise step-by-step 
directions and explanations for patient care procedures 
currently being taught and used throughout Navy 
Medical Department facilities. The 1979 edition will be 
used more extensively than its 1973 counterpart. Not 
only will the manual appear in hospitals and clinics, but 
also in Hospital Corps classrooms and at independent 
duty stations. The new text is intended to reinforce and 
add to previous formal instruction. In addition to being 


distributed to all ships and stations having Medical De- 
partment personnel, private copies of the new manual 
should be available for purchase through the Govern- 
ment Printing Office sometime in September. 

The old manual will be obsolete when the new one is 
issued. To save money, keep your old NAVMED P-5066 
three-ring binder. It can be kept current by using 
lacquer thinner, nail polish remover, or acetone to 
remove "(1973)" and "NURSE CORPS, U.S. NAVY." 

When the price of the new manual has been estab- 
lished, we will announce it along with the GPO address 
for people who want to purchase a private copy. 


Participants in Navy Medical Department part-time 
outservice training are reminded that if they enroll but 
withdraw before completing a course, they are required 
to immediately notify their commanding officer in 
writing. The Naval Health Sciences Education and 
Training Command should be informed of the circum- 
stances causing the withdrawal including a statement 
by the commanding officer concerning determination as 
to whether this action was or was not due to circum- 
stances beyond the individual's control. Further, a 
statement is to be included concerning refunds effected 
or costs to the Government incurred (see BUMEDINST 
1500. 7D). 


Navy Medical Department representatives will par- 
ticipate in a seminar on Asbestos Associated Diseases 
to be held 11-13 Oct 1979 at the Texas Medical Center, 
Houston, Tex. The seminar meets the criteria for 24 
Category I CME credits. The registration fee will be 
$300 per attendee. 

Information may be obtain by writing: The Office of 
Continuing Education, Baylor College of Medicine, 
Texas Medical Center, Houston, Tex. 77030. 


During the American College of Surgeons annual 
meeting, a Navy reception will be held 24 Oct 1979, 
from 1800 to 2000, in the Upper Summit Room of the 
Conrad Hilton Hotel, Chicago. For further information, 
contact: CAPT Robert R. Abbe, MC, USN, Chief of 
Surgery, Naval Regional Medical Center, Great Lakes, 
111. 60088. Telephone: Autovon 792-3629, Commercial 
(312) 688-3629. 

U.S. Navy Medicine 



Based upon the collective experience in defending 
thousands of medical malpractice claims, the Judge 
Advocate General recently recommended certain pro- 
phylactic measures, which are listed here for considera- 

Keep good medical records. The medical record is 
the witness in a case since a physician seldom remem- 
bers the details of treatment at the time of trial. If a 
record is incomplete, illegible, or inaccurate, it may 
lend credence to the patient's claim. 

Do not make admissions in the record. One case was 
lost because a Navy doctor wrote: "Pt. justifiably upset 
that dx. was missed in the clinic." Notwithstanding 
expert testimony that care was proper, the words 
"justifiably upset" led to a $50,000 verdict. 

Consult. There is seldom a valid response to the 
question, "Well, why didn't you consult with the spe- 
cialist, doctor?" 

Maintain good rapport. More than any other single 
thing, good rapport prevents lawsuits. Many patients 
with whom good rapport was maintained refrain from 
filing malpractice claims even though valid grounds 
exist. Conversely, disgruntled patients file claims even 
though their care was entirely appropriate. 

Keep patients informed. This is a major ingredient in 
good rapport. For example, a simple explanation for 
keeping someone waiting may ease the patient's appre- 
hension and tell him in effect, "We haven't forgotten 
you; you're still important to us." AH personnel from 
HR to senior officer could help prevent claims by 
recognizing each patient's dignity as a human being 
and keeping him apprised of his condition and his place 
in the health care delivery system. 

The JAG's recommendations are well founded. It is 
hoped that they can be stressed continually throughout 
the Medical Department. 


On 31 July 1979, the Tri-Service Medical Information 
System (TRIMIS) CAPOC Contract was awarded to 
Marquette Electronics, Inc. of Milwaukee, Wis. The 
contract award culminates many years of effort by 
TRIMIS, Navy, Army, and Air Force personnel. The 

contract provides for computer systems, telecommuni- 
cations, and contractor technical support to satisfy 
electrocardiogram processing requirements in 15 previ- 
ously identified CAPOC regions. The first installation 
will be initiated by 30 Sept 1979, to support NRMC San 
Diego, Calif., and tri-service medical treatment 
facilities throughout southern California and Nevada. 
The regional configuration will consist of the regional 
control center (computer site) at NRMC San Diego, six 
additional Navy and Air Force overread centers (display 
terminal and ECG tracing/ report printers), and 
thirteen additional Navy and Air Force user sites (print- 


Due to a vast improvement in manning throughout 
the Dental Technician Rating, the Dental Assistant, 
basic Class "A" School will return to a 12-week sched- 
ule. The first class under the new schedule will convene 
on 9 Oct 1979. 


The Navy Environmental Health Center has com- 
pleted its move from Cincinnati, Ohio to Norfolk, Va. 
The Center was fully operational 6 Aug 1979. On 20 
July 1979, CAPT John Caruso, Jr. relieved CAPT 
Thomas N. Markham as the commanding officer. The 
new address and telephone numbers are: Navy En- 
vironmental Health Center, Naval Station, Norfolk, Va. 
23511, Autovon: 690-4657, Commercial: (804) 444-4657. 


The Medical Service Corps Division is making a con- 
certed effort within all professional communities for 
which it is responsible — administrative, scientific, and 
clinical — to update information on its officers educa- 
tion, professional certification, sub-specialty training 
and experience, family status, and duty preferences. 
Such information is essential for career planning and 
duty assignment considerations. Each Medical Service 
Corps officer should be responsible for an update of his 
or her preference card (NAVPERS 1301/1-Rev. 8-72). 

Volume 70, September 1979 



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Philadelphia, Pa. 19120 




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scription. Supporters of Navy medicine who are not 
eligible for free distribution, or who want their copy 
sent to their home address may order a personal 

subscription through the U.S. Government Printing 
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